Active NPI
Van McKinley Randolph
- Home Health Aide
- Washington, DC
National Provider Identifier
1306324306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- Practice address
- 1501 Fort Davis St SE
Washington, DC 20020-6025 - Phone
- (202) 808-9369
- NPI assigned
- Aug 1, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | Primary |
Addresses
Primary practice location
1501 Fort Davis St SE
Washington, DC 20020-6025
Mailing address
831 8TH St NE
Washington, DC 20002-3616
Phone (202) 577-3093
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00531676 | Medicaid | DC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533081600000",
"number": "1306324306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "831 8TH ST NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200023616",
"telephone_number": "202-577-3093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 FORT DAVIS ST SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200206025",
"telephone_number": "202-808-9369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "VAN",
"middle_name": "MCKINLEY",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-08-01",
"last_updated": "2018-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00531676",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.